Goal-directed therapy is not as simple as it seems

Vignette A case is discussed of a postmenopausal woman started on alendronate treatment based on a low T-score in the total hip. 3 yr later, her total hip score remains below −2.5, the target set by the ASBMR task force on goal-directed therapy.(1) The important question at this juncture is whether she should change to a different treatment that might result in better improvement in total hip BMD or if she should continue treatment with alendronate.